54235

Injection procedure to cause erection

Medicare pricing data for 3,589 providers across 49 states

🤖AI Overview

Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Injection procedure to cause erection (HCPCS code 54235) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $81.74, but hospitals typically charge $294.94 — a 3.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$16.35

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $81.74, your out-of-pocket cost would be approximately $16.35. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$81.74
Average Hospital Charge
$294.94
Markup Ratio
3.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$294.94
Medicare Allowed$81.74
Medicare Payment$61.26

Hospitals charge 3.6x more than what Medicare allows for this procedure. Medicare actually pays $61.26 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New Jersey$96$369131626+17.0%
District of Columbia$94$243964+15.1%
Hawaii$93$229511+13.4%
Maryland$92$41583418+12.8%
New York$91$4202411,405+11.2%
Puerto Rico$90$137620+9.7%
California$89$3503091,790+8.7%
Delaware$88$2401150+7.9%
Wyoming$88$242415+7.8%
Florida$86$2743932,040+5.5%
Massachusetts$85$32186420+3.9%
Connecticut$84$38250218+2.5%
Pennsylvania$83$241118366+1.7%
Nevada$82$2101883-0.1%
Colorado$81$26778296-1.4%
Oklahoma$80$20956209-2.0%
Michigan$80$209102348-2.0%
Georgia$80$291176773-2.2%
Illinois$79$357123548-2.9%
South Carolina$79$25068437-3.5%
Washington$78$24844146-4.6%
Virginia$78$25183523-4.7%
Arizona$77$212105526-5.3%
Texas$77$2562711,430-5.6%
Montana$76$1671647-6.5%
New Hampshire$76$5161260-6.7%
South Dakota$76$284521-7.0%
Indiana$76$21760265-7.5%
Louisiana$76$21645155-7.6%
Oregon$75$2602265-7.9%
Missouri$75$26076341-7.9%
Wisconsin$75$4434298-8.7%
Ohio$74$259101367-9.2%
Mississippi$74$20123109-9.4%
Kentucky$74$20355196-9.5%
Minnesota$74$33933214-9.9%
Utah$74$20034109-10.0%
Alabama$73$18256331-11.2%
New Mexico$72$233928-11.5%
Nebraska$72$2481236-12.4%
Tennessee$71$23097461-12.7%
Kansas$70$45428116-13.8%
Idaho$70$1741328-14.1%
North Carolina$69$234129415-15.7%
Maine$69$235812-15.7%
Arkansas$68$22338108-16.9%
West Virginia$64$247919-22.3%
Iowa$63$4232263-23.1%
North Dakota$54$1891022-34.2%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber